Anatolian J Cardiol 2015; 15: 77-90
filling pressures (2). These parameters should be included in this study for a better assessment. Again, for the assessment of left ventricular diastolic dysfunction, a comparison between P-wave dispersion and TDI parameters would be more accurate. Daytime ambulatory blood pressure (ABP) is usually higher than nighttime ABP, and the reverse diurnal pattern is independently associated with a higher incidence of cardiovascular events and mortality (4). Reverse-dippers still had approximately twice the risk for stroke versus dippers or non-dippers. Reverse-dippers also had twice as many total cardiovascular events (cardiac and stroke events) as the other dipping groups (5). On the other hand, as you evaluate dipper and non-dipper patient groups, it would be better to include reverse-dipper patients in the study, as this subgroup has the worst prognosis in hypertension patients. Ahmet Göktuğ Ertem, Mehmet Erdoğan, Telat Keleş1, Tahir Durmaz1, Engin Bozkurt1 Department of Cardiology, Atatürk Training and Education Hospital; Ankara-Turkey 1Department of Cardiology, Yıldırım Beyazıd University; AnkaraTurkey
Letters to the Editor
2) Deficient of normal fall of blood pressure at night is associated with increased risk of cardiovascular disease (2). Reverse-dipper or riser patients generate a small portion of hypertensive patients (3). Although this group is at risk for stroke (commonly intracranial hemorrhage), especially in elderly patients (4). However, despite the evidences, reverse-dipping is not mentioned in the valid guide- lines currently (5). The small number of patients was another deficiency in our study to obtain wide-angle data. Consequently, we did not examine and create a reverse-dipper group. Studies involving more patients with longer follow-ups may contribute valuable parts of further guidelines. Oğuz Akkuş Department of Cardiology, Van Education and Research Hospital; Van-Turkey
References 1.
2.
References 1.
2.
3.
4.
5.
Tosu AR, Demir S, Kaya Y, Selçuk M, Akdağ, Işık T, et al. Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients. Anadolu Kardiyol Derg 2014; 14: 251-5. [CrossRef] Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol 2003; 91: 780-4. [CrossRef] Nagueh SF, Appleton PA, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22: 107-33. [CrossRef] Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. J Hum Hypertens 2009; 23: 645-53. [CrossRef] Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Guerrieri M, et al. Altered circadian blood profile and prognosis. Blood Press Monit 1997; 2: 347-52.
Address for Correspondence: Dr. Ahmet Göktuğ Ertem, Atatürk Eğitim ve Araştırma Hastanesi, Kardiyoloji, Bilkent Yolu 3. Km. Ankara-Türkiye
Phone: +90 312 291 25 25 E-mail: [email protected] Available Online Date: 25.12.2014 ©Copyright 2015 by Turkish Society of Cardiology - Available online at www.anakarder.com DOI:10.5152/akd.2014.5748
Author`s Reply To the Editor, We thank all of the authors for their valuable comments, and we were delighted to see your interest to our study (1), entitled “Association of P-wave dispersion and left ventricular diastolic dysfunction in nondipper and dipper hypertensive patients,” published in the April issue of The Anatolian Journal of Cardiology 2014; 14: 251-5. 1) You are right about the mentioned parameters, such as e’, a’, and E/e’; this may be a deficiency of our study. Nevertheless, we will take your advice into consideration for future research.
79
3.
4.
5.
Tosu AR, Demir S, Kaya Y, Selçuk M, Akdağ S, Işık T, et al. Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients. Anadolu Kardiyol Derg 2014; 14: 251-5. [CrossRef] Ohkubo T, Imai Y, Tsuji I, Nagai K, Watanabe N, Minami N, et al. Relation between nocturnal decline in blood pressure and mortality. The Ohasama Study. Am J Hypertens 1997; 10: 1201-7. [CrossRef] Salwa P, Gorczyca-Michta I, Kluk M, Dziubek K, Wozakowska-Kaplon B. Variability of circadian blood pressure profile during 24-hour ambulatory blood pressure monitoring in hypertensive patients. Kardiol Pol 2014; 5: 432-7. [CrossRef] Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 2001; 4: 852-7. [CrossRef] Taylor J. 2013 ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J 2013; 28: 2108-9.
Address for Correspondence: Dr. Oğuz Akkuş, Van Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Van-Türkiye
Phone: +90 326 456 21 42 E-mail: [email protected] Available Online Date: 25.12.2014
Breast arterial calcifications and carotid intima-media thickness and hemodynamics: Is there any association? To the Editor, We have read the article “Breast arterial calcifications and carotid intima-media thickness and hemodynamics: Is there any association?” written by Büyükkaya et al. (1), published in the June 2014 issue of The Anatolian Journal of Cardiology, with great interest. They aimed to investigate the relation between breast arterial calcification (BAC) detected by mammography and two well-known markers of cardiovascular diseases: carotid artery intima-media thickness (C-IMT) and hemodynamic parameters, like carotid peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI). Postmenopausal female patients ranging in age from 40 to 86 were included in their study. They found a statistically significant difference between BAC groups [BAC(+), BAC(-)] in mean C-IMT after adjustments
80
Letters to the Editor
for age (0.81±0.2 mm vs. 0.69±0.2 mm; p
filling pressures (2). These parameters should be included in this study for a better assessment. Again, for the assessment of left ventricular diastolic dysfunction, a comparison between P-wave dispersion and TDI parameters would be more accurate. Daytime ambulatory blood pressure (ABP) is usually higher than nighttime ABP, and the reverse diurnal pattern is independently associated with a higher incidence of cardiovascular events and mortality (4). Reverse-dippers still had approximately twice the risk for stroke versus dippers or non-dippers. Reverse-dippers also had twice as many total cardiovascular events (cardiac and stroke events) as the other dipping groups (5). On the other hand, as you evaluate dipper and non-dipper patient groups, it would be better to include reverse-dipper patients in the study, as this subgroup has the worst prognosis in hypertension patients. Ahmet Göktuğ Ertem, Mehmet Erdoğan, Telat Keleş1, Tahir Durmaz1, Engin Bozkurt1 Department of Cardiology, Atatürk Training and Education Hospital; Ankara-Turkey 1Department of Cardiology, Yıldırım Beyazıd University; AnkaraTurkey
Letters to the Editor
2) Deficient of normal fall of blood pressure at night is associated with increased risk of cardiovascular disease (2). Reverse-dipper or riser patients generate a small portion of hypertensive patients (3). Although this group is at risk for stroke (commonly intracranial hemorrhage), especially in elderly patients (4). However, despite the evidences, reverse-dipping is not mentioned in the valid guide- lines currently (5). The small number of patients was another deficiency in our study to obtain wide-angle data. Consequently, we did not examine and create a reverse-dipper group. Studies involving more patients with longer follow-ups may contribute valuable parts of further guidelines. Oğuz Akkuş Department of Cardiology, Van Education and Research Hospital; Van-Turkey
References 1.
2.
References 1.
2.
3.
4.
5.
Tosu AR, Demir S, Kaya Y, Selçuk M, Akdağ, Işık T, et al. Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients. Anadolu Kardiyol Derg 2014; 14: 251-5. [CrossRef] Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol 2003; 91: 780-4. [CrossRef] Nagueh SF, Appleton PA, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22: 107-33. [CrossRef] Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. J Hum Hypertens 2009; 23: 645-53. [CrossRef] Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Guerrieri M, et al. Altered circadian blood profile and prognosis. Blood Press Monit 1997; 2: 347-52.
Address for Correspondence: Dr. Ahmet Göktuğ Ertem, Atatürk Eğitim ve Araştırma Hastanesi, Kardiyoloji, Bilkent Yolu 3. Km. Ankara-Türkiye
Phone: +90 312 291 25 25 E-mail: [email protected] Available Online Date: 25.12.2014 ©Copyright 2015 by Turkish Society of Cardiology - Available online at www.anakarder.com DOI:10.5152/akd.2014.5748
Author`s Reply To the Editor, We thank all of the authors for their valuable comments, and we were delighted to see your interest to our study (1), entitled “Association of P-wave dispersion and left ventricular diastolic dysfunction in nondipper and dipper hypertensive patients,” published in the April issue of The Anatolian Journal of Cardiology 2014; 14: 251-5. 1) You are right about the mentioned parameters, such as e’, a’, and E/e’; this may be a deficiency of our study. Nevertheless, we will take your advice into consideration for future research.
79
3.
4.
5.
Tosu AR, Demir S, Kaya Y, Selçuk M, Akdağ S, Işık T, et al. Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients. Anadolu Kardiyol Derg 2014; 14: 251-5. [CrossRef] Ohkubo T, Imai Y, Tsuji I, Nagai K, Watanabe N, Minami N, et al. Relation between nocturnal decline in blood pressure and mortality. The Ohasama Study. Am J Hypertens 1997; 10: 1201-7. [CrossRef] Salwa P, Gorczyca-Michta I, Kluk M, Dziubek K, Wozakowska-Kaplon B. Variability of circadian blood pressure profile during 24-hour ambulatory blood pressure monitoring in hypertensive patients. Kardiol Pol 2014; 5: 432-7. [CrossRef] Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 2001; 4: 852-7. [CrossRef] Taylor J. 2013 ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J 2013; 28: 2108-9.
Address for Correspondence: Dr. Oğuz Akkuş, Van Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Van-Türkiye
Phone: +90 326 456 21 42 E-mail: [email protected] Available Online Date: 25.12.2014
Breast arterial calcifications and carotid intima-media thickness and hemodynamics: Is there any association? To the Editor, We have read the article “Breast arterial calcifications and carotid intima-media thickness and hemodynamics: Is there any association?” written by Büyükkaya et al. (1), published in the June 2014 issue of The Anatolian Journal of Cardiology, with great interest. They aimed to investigate the relation between breast arterial calcification (BAC) detected by mammography and two well-known markers of cardiovascular diseases: carotid artery intima-media thickness (C-IMT) and hemodynamic parameters, like carotid peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI). Postmenopausal female patients ranging in age from 40 to 86 were included in their study. They found a statistically significant difference between BAC groups [BAC(+), BAC(-)] in mean C-IMT after adjustments
80
Letters to the Editor
for age (0.81±0.2 mm vs. 0.69±0.2 mm; p
